A PHOTOELASTIC MODEL OF THE PATELLOFEMORAL JOINT TO STUDY PATELLAR HEIGHT

Background: Patellar height has been related to anterior knee pain and Osgood–Schlatter disease. To study the influence of patellar height on knee biomechanics, a bidimensional photoelastic prototype of the patellofemoral joint was developed. Methods: Nine tests were performed at different knee flexion angles and patellar heights. A free body diagram was constructed for each test. The following parameters were calculated: lengths (patella, patella thickness and ligamentum patellae); patellar height index; angles (knee flexion, patellar flexion, quadriceps and ligamentum patellae force and reaction force at the ankle); moment arms (extensor, quadriceps and ligamentum patellae in relation to both the tibiofemoral and patellofemoral contact points), effective moment arm and forces around the extensor mechanism relative to the applied force. Results: Femoropatellar and femorotibial reaction forces were greater with increased knee flexion and a fixed patellar height. With fixed knee flexion and different patellar heights, these forces were greater if the patella was elevated. A decrease in the angle between the tibial axis and ligamentum patellae was observed when patellar height increased. Patellar flexion angle increased when patellar height increased. This was accompanied by an increase in the angle of action of the quadriceps force. Extensor moment arm decreased with increased patellar height when knee flexion and the tibiofemoral contact point were fixed. Conclusion: A new application of photoelasticity is presented. The preliminary findings obtained confirm the influence of patellar height on patellar biomechanics, and specifically on forces around the extensor mechanism of the knee.

Die patellare Tendinopathie

Zusammenfassung. Sportliche Aktivitäten mit Sprungabläufen stellen für die Kniegelenke eine mechanische Herausforderung dar. Häufig projizieren sich chronisch auftretende, atraumatische Beschwerden auf den Patellaunterpol, welcher pathomorphologisch eine patellare Tendinopathie entspricht. Extrinsische und intrinsische Risikofaktoren können unterschieden werden. In der klinischen Untersuchung zeigt sich ein meist unauffälliges Knie mit einer Druckdolenz am kaudalen Teil der Kniescheibe beim Übergang zum Ligamentum patellae. In der Bildgebung ist sonografisch ein degenerierter Sehnenanteil der tiefen Patellarsehne zu erkennen, der magnettomografisch mit Hyperintensität des Hoffa-Körpers einhergehen kann. Abhängig von der klinischen Entwicklung wird das Jumper’s Knee nach Blazina Grad I–IV eingeteilt. Bis zu 90 % der Patienten können konservativ therapiert werden. Operativ stehen offene und arthroskopische Verfahren mit ordentlichem Resultat zur Verfügung.

Differences in the rehabilitation period following two methods of anterior cruciate ligament replacement: Semitendinosus / gracilis tendon vs. Ligamentum patellae

In this study we have analyzed outcome during the early rehabilitation period phase following two different methods of anterior cruciate ligament (ACL) reconstruction: ligamentum patellae (LP) and semitendonosus/gracilis tendon (SG) based reconstruction. This study included 40 patients treated by each method, examined 6 weeks and 3, 6 and 12 months after surgery. Patients in the SG group showed significantly better Lysholm scores at 6 and 12 months, Tegner Activity Scale scores at 3 months, and pain profile assessments at 6 weeks and 3 months than those in the LP group. Significant differences were observed in LP group in range-of-motion at 6 weeks and 3 and 6 months post-surgery. Stability tests revealed no significant differences between patients in the two groups. SG-based reconstruction of the ACL thus demonstrated advantages over LP-based reconstruction regarding pain and function, while LP-based reconstruction was associated with an earlier return of motion.